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Returning Student Athletes

For All Returning Student-athletes:

Please read through this page thoroughly!

If you are a 'returning student-athlete', congratulations on your decision to continue your collegiate career at Kutztown University for 2014-15. We wish you the best for a safe and successful season. At this time we would like to begin to work on the "safe" part of your season.

Below are ALL of the medically related forms that MUST be completed before you can be cleared to participate in any official Kutztown University Intercollegiate Athletic activity.  Please read the REVISED Procedures Regarding Athletic Participation, Injuries, Illness and Medical Care. Please read thoroughly the information presented in these forms and fill out completely.

Remember to: submit ALL requested materials; sign and date each form; return all completed forms no later than the indicated return date below.

It is extremely vital that you return all of the requested forms and requested materials by the return date listed. This allows the Sports Medicine Staff time to review the information and contact individuals if necessary. Failure to do so will delay your ability to receive a physical and subsequent participation in Kutztown University Athletics at the earliest opportunity.

*Questions*

If you have any questions regarding the Sports Medicine forms or procedures, please contact Faculty Athletic Trainer, Jack Entriken, via email at entriken@kutztown.edu

 

RETURN DATE:

All Sports: July 1-15th

 

Mail all forms & related correspondence to:

    Kutztown University of PA

    Attn: Athletic Physical Info-Returner

    Health & Wellness Services

    PO Box 730

    Kutztown, PA 19530.

 

NOTE:   

Please DO NOT Fax documents.

Please complete the forms and MAIL them ASAP so they are received near the Deadline date.

 

The following is a check list of required forms:

  **   1.  Athletic Medical History Form

**All Returners should have updated their Athletic Medical History form at the end of the Spring semester. If you Failed to update your form, contact Faculty Athletic Trainer, Jack Entriken, via email at entriken@kutztown.edu, to schedule an appointment over the summer to complete this process.

                   a. NCAA ADD/ADHD form (ONLY if diagnosed with ADD/ADHD)

         2.  Athletic Insurance Information Form

         3.  Medical Bills Letter of Responsibility Form

         4.  Medical Disclosure Form

         5.  Medical Consent/Release Form

         6.  Student-Athlete Injury & Illness Acknowledgement Form

         7.  Sickle Cell Trait Reporting Form (NCAA Policy)

    Note: Students who previously submitted their Newborn Screen results or Blood Test results do not need to submit this form, BUT if you previously signed the Sickle Cell Trait Waiver you MUST again complete this form.

 

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(Click Here to download/update the most recent version of this program)

 

1.  Athletic Medical History Form

This form was updated by all returning student-athletes in team meetings at the end of the Spring Semester. If you Failed to update your form, contact Faculty Athletic Trainer, Jack Entriken, via email at entriken@kutztown.edu, to schedule an appointment over the summer to complete this process.

 

Note:  Remember to update the Sports Medicine Office of ANY changes to your health status that may have occurred over the summer.

IMPORTANT NOTICE:

ONLY for those students who have been diagnosed with

Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder

If you have been diagnosed with ADD/ADHD here are the NCAA Guidelines for Reporting Treatments for ADD/ADHD, which is required annually.

(Click here for required form)

 2.  Athletic Insurance Information Form

(You MUST type in all information before printing. Hand written forms will NOT be accepted as complete.)

NOTE: Please mail the original with a 'legible' copy of your insurance card taped to the form in the appropriate boxes.

Please read the Policy & Procedures Regarding Athletic Participation, Injuries, Illnesses and Medical Care.   Click Here to open the document.

 

3.  Medical Bills Letter of Responsibility Form

4.  Medical Disclosure Form

It is important to submit ALL documentation related to any injury/illness over the summer prior to your first approved practice activity.

 

5.  Medical Consent/Release Form

6.  Student-Athlete Injury & Illness Acknowledgement Form

SPECIAL ALERT!

It is Recommended that all KU Student-Athletes go to this web-page to review additional Concussion education items and complete the Student-Athlete Injury Illness Acknowledgement Form.

Click on the following link:

"Concussions in Collegiate Sports:  An Overview of Facts, Policy, & Practice"

 

7.   Sickle Cell Trait Reporting Requirement (Click here)

      Note: Student who previously submitted their Newborn Screen Results or Blood test results do not need to resubmit this form, BUT if you sign the Sickle Cell Trait Waiver you MUST again submit this form.


Mail all forms & related correspondence to:

    Kutztown University of PA
    Attn: Athletic Physical Info-Returner
    Health & Wellness Services
    PO Box 730
    Kutztown, PA 19530.